Provider Demographics
NPI:1376286534
Name:DROSEN, SOFYA P (DO)
Entity type:Individual
Prefix:
First Name:SOFYA
Middle Name:P
Last Name:DROSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SOFYA
Other - Middle Name:
Other - Last Name:PEYSAKHOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1727 SHAWANO AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3268
Mailing Address - Country:US
Mailing Address - Phone:920-431-1810
Mailing Address - Fax:
Practice Address - Street 1:1727 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3268
Practice Address - Country:US
Practice Address - Phone:920-431-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program